Towards a comprehensive tobacco-cessation approach: A pilot-training using simulation based-learning among medical students in Türkiye

Tobacco control (TC) is underpinned in two main strategies: preventing youth initiation and promoting tobacco cessation among users 1 . Healthcare professionals (HCPs), and specially physicians, should lead TC advocacy efforts, emphasize their role as TC leaders and exemplars

and simulated patient and objective structured clinical examination (OSCE) rooms.
Tobacco-cessation outpatient clinic applications, tobacco addiction treatment monitoring system, pulmonary function test, and carbon monoxide measurements were performed with simulated patients using OSCE rooms (Figure 1).An online pre-post questionnaire evaluating baseline and posttraining participants' knowledge was administered.Pre-test and post-test scores were compared with the related-samples Wilcoxon signed rank test.
Most participants reported attending only one annual TC lecture in their medical school; 41% considered TC contents insufficient in number and content.While the pre-test score ranged from 28 to 76 points (out of 110 total score), the post-test score ranged from 70 to 108 points; the pre-post test improvement rate was between 55% and 222%.The mean scores for the pre-test and post-test were 53.89 ± 16.47 and 94.54 ± 10.78, respectively (p<0.001).Students emphasized that the pilot learning experience on the 5As/5Rs model, both theoretical and practical, was very productive, in contrast to their medical education.In addition, they stated that the learning experience o f t o b a c c o -r e l a t e d diseases is valuable in establishing tobacco as the main preventable cause of lung and heart diseases, emphasizing the role of prevention.They also stated that a p p l y i n g s m o k i n gcessation approaches in OSCE rooms in three different curriculum units (pulmonology, family medicine, psychiatry) was reinforcing both for practicing in different settings and for gaining practical skills.
This project is innovative in smoking cessation medical education, while using simulation-based learning methods in addition to examples of tobaccorelated diseases given with virtual scenarios.In previous research combining a 4-hour theoretical and  interactive practical course, students' knowledge levels significantly increased compared to their base levels 12 .In our study, a significant increase was also observed in the pre-test and post-test levels.A previous study investigated how often tobacco control courses are given in medical education and the expectations of educators and students: it concludes that students demand to discuss the relationship between tobacco exposure and disease development in more detail.In addition, students stated that they would be more prompt in applying brief tobacco cessation practices such as 5As/5Rs to patients by explaining this association 9 .Another study emphasized that medical students were inadequately prepared to help patients change harmful behaviors such as tobacco use 10 .In our project, the link between tobacco use and the diseases was comprehensively discussed.Beside counselling skills, clinical benefits and the effects of quitting on the course of these diseases were discussed interactively.
In conclusion, integrating tobacco-cessation training in medical schools is feasible and well received by the students.In order to insert this practice in the medical education curriculum and to implement it consistently, educators' as well as trainers' motivation are also required.In this context, a main asset would be to receive support and contributions from international experts on tobacco control.

Figure 1 .
Figure 1.Education and training classrooms used throughout the course at the Recep Tayyip Erdoğan University Clinical Simulation Training Center during the project 'Competent physician training program in tobacco control and cessation', 23-25 September 2022, Rize, Türkiye